急性肺栓塞56例诊治体会

摘要

目的：探讨急性肺栓塞的临床表现、诊断及治疗方法。方法：回顾性分析笔者所在医院收治的56例急性肺栓塞患者的临床资料，包括临床表现、辅助检查、治疗方法以及临床疗效。结果：56例患者中，呼吸困难55例(98.2%)，晕厥22例(39.3%)，胸痛11例(19.6%)，咳嗽9例(16.1%)，抽搐6例(10.7%)，咯血4例(7.1%)，呼吸困难、胸痛、咯血三联征3例(5.4%)。动脉血气分析、心电图、胸部X线、超声心动图均有助于诊断，而肺增强螺旋CT诊断准确率最高。给予患者解热镇痛、吸氧、监测的一般治疗，并给予抗凝联合溶栓治疗。5例患者死亡，存活率91.0%。结论：急性肺栓塞临床症状并不典型，容易误诊、漏诊，临床应足够重视，肺增强螺旋CT为重要的辅助检查，而早期抗凝联合溶栓治疗能够达到良好的临床疗效。%Objective:To investigate the clinical manifestations,diagnosis and treatment of acute pulmonary embolism.Method:The clinical data of 56 cases with acute pulmonary embolism were retrospectively analyzed,including clinical manifestations,laboratory tests,treatment methods,and clinical efficacy.Result:There were 55 cases(98.2%) of dyspnea,22 cases(39.3%) of syncope,11 cases(19.6%) of chest pain,9 cases(16.1%) of cough,6 cases(10.7%) of convulsions,4 cases(7.1%) of hemoptysis,3 cases(5.4%) of dyspnea,chest pain,hemoptysis triad.Arterial blood gas analysis,electrocardiogram,chest X-ray,echocardiography were helpful in the diagnosis,and enhanced spiral CT pulmonary had highest accuracy rate.Thermal analgesia,oxygen,monitoring of the general treatment were given to patients as well as anticoagulation combined with thrombolytic therapy.Five patients died,and the survival rate was 91.0%. Conclusion:The clinical symptoms of acute pulmonary embolism are not typical,easy to misdiagnose,and clinical attention should be sufficient.Lung enhanced helical CT can be used as an important auxiliary examination,and early anticoagulation combined thrombolytic therapy can achieve good clinical efficacy.